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Getting Ready for Certification

Useful Test-Taking Strategies When Preparing for the WOCNCB Continence Examination

Thompson, Donna L.

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Journal of Wound, Ostomy and Continence Nursing: July/August 2016 - Volume 43 - Issue 4 - p 425-426
doi: 10.1097/WON.0000000000000246
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The WOCNCB certification examinations contain 120 multiple-choice test items. All items are written by practicing WOCNCB certified nurses, and all are carefully reviewed by a committee of certified nurses in the respective specialty area. The Examination Committee and the Item Review Committee are composed of expert and novice certified nurses; they review each question to ensure that items used on the certification examinations test current wound, ostomy, and continence (WOC) practice across the country and accurately reflect entry-level specialty practice. All examination items are pretested and statistically analyzed. Each examination has 10 items being pretested that are not scored and do not affect the candidate's score. Every item on WOCNCB examinations undergoes a rigorous statistical evaluation by the testing specialists at Castle Worldwide, the WOCNCB's testing company. Pretesting items and scored items on the examinations are statistically analyzed each time they are used. Items are removed from the exam if not found to be statistically sound; these are then placed into the review process again, as if a new item. The WOCNCB takes seriously its role as the “gold standard” for WOC and foot care nursing.

Understanding and employing simple test-taking strategies can help candidates evaluate multiple-choice questions and achieve successful results. First, read the question or “stem” critically and carefully. Identify key words such as “assess,” “teach,” or “refer.” These words direct the test taker to what action is needed by the nurse in a given situation. Pay attention to details in the question stem such as age of a patient, gender, or past medical history. Details are included in the question for a reason and help you identify the correct answer. Try to formulate an answer before you look at the options or read the question with each answer option. Eliminate options that you know to be incorrect. If any part of an answer is wrong, the entire option is wrong. For example, if a question asks what are symptoms of stress urinary incontinence (SUI) and answer options list a combination of 3 symptoms; all 3 symptoms must be a symptom of SUI. An answer option that lists these 3 symptoms: leakage with walking, coughing, and with urge on the way to the toilet is incorrect. Only 2 of the 3 symptoms are correct; leakage associated with urge while on the way to the toilet is not a common symptom of SUI, it best describes urgency incontinence.

Examination questions often present a patient scenario or case that requires you to apply your knowledge of WOC nursing. Avoid reading too much into the scenario. Questions on the certification examination are not designed to trick you or “trip you up.” Many WOCNCB test takers have some level of experience in the specialty, and all are experienced nurses. It is difficult not to apply past experience to the question. In most cases, when you think the question is tricky, reread the question and consider evidence-based practice knowledge, especially when deciding between 2 options that seem correct. We advise you to avoid the tendency to apply your personal anecdotal experience to determine the correct answer. Avoid rewriting the question in your head as you think it “should” be worded. Read the question at face value and choose a response that simply answers the question. The WOCNCB Web site has many resources to help with test taking and test preparation (www.wocncb.or/certification/exam).

PRACTICE QUESTIONS

  • 1. A 70-year-old woman with congestive heart failure and diabetes mellitus is having frequent episodes of urinary incontinence. She reports leaking urine without warning and associates leakage with a cough or sneeze. Which intervention is indicated to manage her incontinence?
  • Antimuscarinic therapyTopical estrogenPelvic muscle exercisesScheduled toileting

ANSWER C:

Exam outline: Task 2/030203 Implementing management techniques

Cognitive level: Analysis

This scenario most accurately describes symptoms of stress incontinence, of which there is good evidence to support pelvic floor muscle training as first-line treatment. The test taker needs to evaluate all the information given in the stem in order to choose the correct answer Diabetic patients are at higher risk to develop urgency and urge incontinence, appropriate for treatment with antimuscarinic therapy. The information in the stem does not indicate symptoms of urge incontinence. Antimuscarinics should be used with caution in older adults due to the potential for cognitive impairment. Topical estrogen would be a treatment option if this patient presented with symptoms of atrophic vaginitis, but it is not a recommended first-line treatment for stress incontinence. Scheduled toileting would be an appropriate first-line treatment if the scenario presented evidence of functional incontinence in this woman, such as impaired access to the toilet. Age alone is not a criterion for functional incontinence.

1. Engberg S. Urinary incontinence/voiding dysfunction in the female. In: Doughty DB, Moore KN, eds. Wound, Ostomy and Continence Nurses Society Core Curriculum Continence Management. Philadelphia, PA: Wolters Kluwer; 2016:155–163.

2. Moore K, Dumoulin C. Adult conservative management. In: Abrams P, Carsozo L, Khoury S, Wein A, eds. Incontinence: 5th International Consultation on Incontinence. 5th ed. European Association of Urology/ICUD; 2013:1101–1228.

  • 2. Which PVR (postvoid residual) measurement in a middle-aged male with incontinence and a history of UTI (urinary tract infection) requires referral for further evaluation?
  • 25 mL50 mL100 mL250 mL

ANSWER D:

Outline location: Task 2/030206 Recommending appropriate consultations

Cognitive level: Application

Many expert panels consider a PVR of less than 50 mL to be normal and a PVR of 50 to 100 mL to be the low side of abnormal. The WOC nurse needs to consider ranges of normal and match that to the patient problem. In this case, we have a middle-aged male with a history of UTI. A key word in the question is “requires” directing the test taker to identify a number that would always require referral. A PVR of 250 mL in a male would always be considered abnormal. In the case stated here, a history of UTI points toward inadequate bladder emptying, possible obstructed flow of urine, and a potential danger to the upper urinary tract. Referral to an urologist would be required in this case.

1. Agency for Health Care Policy and Research. Clinical Practice Guideline: Urinary Incontinence in Adults. Rockville, MD: Dept of Health and Human Services (US), Agency for Health Care Policy and Research; 1996. AHCPR Pub. No. 96-0682.

2. Kruse K. Primary assessment guidelines. In: Doughty DB, Moore KN, eds. Wound, Ostomy and Continence Nurses Society Core Curriculum Continence Management. Philadelphia, PA: Wolters Kluwer; 2016:37–38.

3. Staskin D, Kelleher C. Initial assessment of urinary incontinence in adult male and female patients (5A). In: Abrams P, Carsozo L, Khoury S, Wein A, eds. Incontinence: 5th International Consultation on Incontinence. 5th ed. European Association of Urology/ICUD; 2013:361–388.

  • 3. The continence nurse is teaching a patient about strategies to manage urgency and urgency incontinence. Which of the following maneuvers would be the initial step to instruct the patient in suppressing urinary urge?
  • Distract attention away from the urgeWait a few minutes and then go to the toiletSqueeze and hold the pelvic floor muscles for 10 secondsQuickly squeeze and relax the pelvic floor muscles 3 to 5 times

ANSWER D:

Outline location: Task 2/030205 Educating patient and caregivers on healthy bladder and bowel habits

Cognitive level: Recall

Urgency suppression is an effective strategy in the management of urge urinary incontinence. Detrusor contractions can be inhibited by voluntarily contracting the pelvic floor muscles. The question asks the test taker to recall the steps in urge suppression. The continence nurse would initially instruct the patient to not rush off to the toilet with the initial sensation of strong urge. Rushing to the toilet can stimulate a detrusor contraction and increase intra-abdominal pressures. A sustained muscle contraction is appropriate as part of a pelvic muscle strengthening program whose goal is to improve muscle tone. Initially, the patient is taught to strongly and quickly contract the pelvic floor muscles repetitively to inhibit the urge. After the quick muscle contractions, patients are instructed to distract their attention to some other thoughts as a further strategy to suppress urge. Once the strong urge has subsided, the patient is instructed to go to the toilet.

REFERENCES

1. Gibson W, Wagg A. Overactive bladder/urgency UI. In: Doughty DB, Moore KN, eds. Wound, Ostomy and Continence Nurses Society Core Curriculum Continence Management. Philadelphia, PA: Wolters Kluwer; 2016:65.
    2. Moore K, Dumoulin C. Adult conservative management. In: Abrams P, Carsozo L, Khoury S, Wein A, eds. Incontinence: 5th International Consultation on Incontinence. 5th ed. European Association of Urology/ICUD; 2013:1101–1228.
      © 2016 by the Wound, Ostomy and Continence Nurses Society.